Final cbt seminar

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OUTLINE OF THE PRESENTATION <ul><li>Introduction On CBT- Historical Background </li></ul><ul><li>Principles – Assumptions & Theoretical Basis </li></ul><ul><li>Components Of CBT </li></ul><ul><li>Techniques Of CBT </li></ul><ul><li>CBT Used In Various Disorders </li></ul><ul><li>Models Of Psychotherapy Using CBT </li></ul><ul><li>Indications And Contraindications For CBT </li></ul><ul><li>Research On CBT </li></ul><ul><li>CBT Practice With Children </li></ul><ul><li>CBT Practice With Adults </li></ul><ul><li>Advantages And Disadvantages </li></ul><ul><li>CBT – TRAINING AND SKILLS OF The THERAPIST </li></ul><ul><li>Simple Guidelines For Practice </li></ul><ul><li>CBT And Social Work </li></ul>

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INTRODUCTION ON CBT- HISTORICAL BACKGROUND <ul><li>Men are disturbed, not by things, but by the principles and notions which they form concerning things </li></ul><ul><li>( Epictetus 55 - 135 AD) </li></ul>

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<ul><li>Mental Illness is defined as “ All diagnosable mental disorders, health conditions characterized by alterations in thinking, mood, behaviour ( or some combination thereof) associated with distress and / or impaired functioning “ (Surgeon General’s Report, US Health and Human Services, 1999) </li></ul><ul><li>Mental health problems can be conceptualized as disruptions in the interactions between the individual, group, and the environment producing a diminished rate of positive mental health(Scanlon et al, 1997) </li></ul>

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<ul><li>PSYCHODYNAMIC </li></ul><ul><li>Probes the past and does not tackle the immediate problem </li></ul><ul><li>Explores the unconscious </li></ul><ul><li>The goal is to bring insight into the client </li></ul><ul><li>It takes a long time </li></ul><ul><li>Methods used are free association, dream analysis and transference </li></ul><ul><li>HUMANISTIC & EXISTENTIAL </li></ul><ul><li>Client centred by Carl Rogers </li></ul><ul><li>Focus on self actualization and explore the meaning of existence </li></ul><ul><li>Emphasis on emotion and experience </li></ul><ul><li>emphasis on non-directive approaches to therapy </li></ul><ul><li>Empathy, warmth, active listening, unconditional positive regard </li></ul>

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<ul><li>BEHAVIOURAL </li></ul><ul><li>There are no mental processes (will, mind) </li></ul><ul><li>Derived from classical and operant conditioning </li></ul><ul><li>The focus is on changing the behavior </li></ul><ul><li>Works on the immediate problem </li></ul><ul><li>Focuses on the present </li></ul><ul><li>Techniques based on classical, operant conditioning & learning </li></ul><ul><li>COGNITIVE </li></ul><ul><li>emphasis is on internal thought processes </li></ul><ul><li>Addresses cognitive distortions </li></ul><ul><li>challenges client’s distorted thinking through a process of checking beliefs against reality </li></ul>

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<ul><li>The fundamentals of cognitive behaviour therapy have been around since ancient Greeks </li></ul><ul><li>Cognitive Behavioural Theories evolved from bi-directional movements in the existing fields of cognitive psychology and behavioural science </li></ul><ul><li>The evolution of CBT took place in 3 stages </li></ul>

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Phase III: CBT dominance <ul><li>Over the past 20 years, the cognitive and behavioural theories have become more inter-connected, emphasizing both behaviour and thinking </li></ul><ul><li>Cognitive-behavioural therapy is becoming the dominant paradigm in clinical psychology </li></ul>

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<ul><li>Cognitive Therapy is a system of psychotherapy that attempts to reduce excessive emotional reactions and self-defeating behaviour, by modifying the faulty or erroneous thinking and maladaptive beliefs that underlie these reactions (Beck et al 1976, 1979, 1993) </li></ul>

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<ul><li>CBT is the integrative, unified theories of cognition and learning with treatment techniques derived from cognitive and behavioural therapies </li></ul><ul><li>Focused form of psychotherapy based on a model suggesting that psychiatric or psychological disorders involve dysfunctional thinking </li></ul>

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<ul><li>The way an individual feels and behaves is influenced by the way he/she structures his/her experiences </li></ul><ul><li>Modifying dysfunctional thinking provides improvements in symptoms and modifying dysfunctional beliefs that underlie dysfunctional thinking leads to more durable improvement </li></ul>

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<ul><li>BEHAVIOURAL PRINCIPLES </li></ul><ul><li>Basic assumption of behavioural theories is that maladaptive behaviours are learned and can be unlearned, and that new, more adaptive behaviours can be learned </li></ul><ul><li>Has been applied to a wide range of disorders and problems </li></ul>

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<ul><li>COGNITIVE PRINCIPLES </li></ul><ul><li>Cognitive principle – it is interpretations of events, not events themselves, which are crucial. </li></ul><ul><li>Behavioural principle – what we do has a powerful influence on our thoughts and emotions </li></ul><ul><li>The continuum principle – mental health problems are best conceptualised as exaggerations of normal processes </li></ul>

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<ul><li>‘ Here and now’ principle – it is usually more fruitful to focus on current processes rather than the past </li></ul><ul><li>Interacting systems principle – it is helpful to look at problems as interactions between thoughts, emotions, behaviour and physiology and the environment in which the person operates </li></ul>

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<ul><li>Basic assumption of cognitive theories is that maladaptive behaviour results from irrational or distorted ways of thinking – emphasis is on internal thought processes </li></ul><ul><li>Like psychodynamic theories, cognitive theories have been employed mostly with people with anxiety and mood disorders </li></ul><ul><li>Like behavioural theories, there is a strong research emphasis in cognitive theories </li></ul>

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NEGATIVE AUTOMATIC THOUGHTS <ul><li>Automatic thoughts are the thoughts that come to mind involuntarily and effortlessly </li></ul><ul><li>Most of our thoughts are automatic – they happen without being planned or intended </li></ul><ul><li>Clients may not even notice them unless you make a point of looking for them </li></ul><ul><li>They may or may not have an affect on client’s feelings, moods or behaviour </li></ul><ul><li>When they do, their effects can be beneficial, harmful or neutral </li></ul><ul><li>Some automatic thoughts can cause serious problems </li></ul>

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MALADAPTIVE SCHEMAS <ul><li>Sometimes automatic thoughts turn out to have a shared theme called “schema” </li></ul><ul><li>They take the form of basic assumptions, attitudes or beliefs that influence a person’s thinking indirectly but powerfully </li></ul><ul><li>Eg : I am not a likable person </li></ul>

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MIDDLE STAGE <ul><li>Approximately 4-10 sessions </li></ul><ul><li>Help client to accept responsibility for personal change </li></ul><ul><li>Establish the extent to which the client engages in behaviours that temporarily relieve and/or enable avoidance of the problem but which are counterproductive </li></ul><ul><li>Continue to maintain a collaborative therapeutic relationship </li></ul>

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<ul><li>Teach client about cognitive distortions </li></ul><ul><li>Shift focus of therapy from negative automatic thoughts to more helpful thoughts </li></ul><ul><li>Educate client about self-acceptance </li></ul><ul><li>Pass responsibility for therapeutic work over to the client </li></ul><ul><li>Encourage the client to become her own therapist </li></ul>

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<ul><li>Help the client to summarise what has been learnt and understands appropriate techniques </li></ul><ul><li>Praise the client for genuine efforts </li></ul><ul><li>Decide when to end therapy consistent with the development of cognitive conceptualisation </li></ul><ul><li>Explore obstacles to ending </li></ul><ul><li>Develop action plan for potential problems </li></ul>

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Personality Disorders <ul><li>Success rate better in BPD </li></ul><ul><li>Assessment </li></ul><ul><li>Therapy uses less Socratic and more confrontative </li></ul><ul><li>Skills training </li></ul><ul><li>More research is on the way </li></ul>

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INDICATIONS FOR CBT <ul><li>Neurotic disorders </li></ul><ul><li>Client to have insight to some extent </li></ul><ul><li>Good therapeutic relationship </li></ul><ul><li>Considered effective treatment for depression </li></ul><ul><li>Also considered first line of psychotherapy for anxiety disorders, sexual dysfunctions as in uncomplicated cases </li></ul><ul><li>Cases of schizophrenia with negative symptoms </li></ul>

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CONTRAINDICATIONS FOR CBT <ul><li>Generally not indicated for people with thought disorders </li></ul><ul><li>People with compromised intelligence </li></ul><ul><li>People with organic brain disorders </li></ul><ul><li>People who do not have good grasp of therapy language </li></ul><ul><li>People not accepting the premise of the treatment </li></ul><ul><li>Schizophrenia cases with positive symptoms </li></ul><ul><li>Severe suicidal ideas </li></ul>

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CBT PRACTICE WITH CHILDREN <ul><li>Research shows children suffer from a variety of Anxiety Disorders </li></ul><ul><li>CBT is considered the first line of treatment parallel to pharmacotherapy </li></ul><ul><li>Cognitive approaches to parents of children with eating disorders, ODD, LD and sleeping disorders help parents in better management of such children </li></ul>

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<ul><li>CBT is also used in cases of children with ADHD, panic disorder, phobias, OCD, PTSD </li></ul><ul><li>Also for children and adolescents with unipolar depression </li></ul><ul><li>Treatment option for aggressive behaviour in youth </li></ul>

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CBT PRACTICE WITH ADULTS <ul><li>In case of adults, CBT is extensively used for depression </li></ul><ul><li>There are more studies supporting good outcome in OCD </li></ul><ul><li>Persons with alcohol and substance use disorders can be helped through CBT </li></ul>

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ADVANTAGES AND DISADVANTAGES <ul><li>Advantages of Cognitive Behavior Therapy </li></ul><ul><ul><li>It has established human thought processes as data or events that can be studied. </li></ul></ul><ul><ul><li>It validated a number of relaxation techniques. </li></ul></ul><ul><ul><li>It has enhanced the rational therapies such as Rational Emotive Behavior Therapy. </li></ul></ul><ul><ul><li>Uses the systematic scientist-practitioner model </li></ul></ul>

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<ul><li>Disadvantages of Cognitive Behavior Therapy </li></ul><ul><li>It has been harshly judged by feminists, multiculturalists and ecologists because it mirrors masculine and Euro-American worldviews and does not adequately take culture into consideration. </li></ul><ul><li>It requires a lot of training and skill. The therapist needs to not only understand cognitive techniques but also have a vast understanding of behavioral and learning theories. </li></ul><ul><li>The therapist needs to have strong discipline and there is less tolerance for error. </li></ul>

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<ul><li>The minimum requirement as in abroad is a diploma in CBT -3 months course </li></ul><ul><li>The students or practitioners of ther froms of psychotherapy can attend the workshops whenever conducted </li></ul><ul><li>The graduation and post graduation in psychology offers training </li></ul><ul><li>Clinical practice and adequate supervision and guidance from well established practitioners </li></ul>

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Social Work Practice and CBT <ul><li>Client’s shift from passive recipient to active partner in treatment </li></ul><ul><li>Need for incorporation of diversity issues into interventions </li></ul><ul><li>Call for evidence based practice </li></ul>

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<ul><li>Social workers should look for short-term, concrete, operational, and effective treatment methods which are measurable </li></ul><ul><li>learn to routinely apply initial assessment tools as well as evaluation methods to research their own treatment outcomes </li></ul><ul><li>a powerful need exists to teach clients specific skills that will enable them to resolve and cope with their own problems </li></ul>

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CBT application by the students in Dept PSW <ul><li>An analysis of case records done in Psychiatric Social Work Department </li></ul><ul><li>Case Records from 2004 to 2009 </li></ul><ul><li>60 case records were analysed </li></ul><ul><li>CBT was used in 50 cases out of 306 cases </li></ul><ul><li>The following was the impression based on symptom reduction </li></ul>

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CONCLUSION <ul><li>CBT is an integrative therapeutic approach that assumes that cognitions, physiology and behaviours are all functionally interrelated. </li></ul><ul><li>The treatment aims at identifying and modifying biased and distorted thought processes, attitudes and attributions as well as problematic behaviours via techniques actively involving the client participation in cognitive restructuring, self monitoring </li></ul><ul><li>As such the treatment goal is to develop more rational and adaptive cognitive structure as a pathway to rid off maladaptive patterns of behaviour and improve affect </li></ul>